Valvular Excrescences: A Possible Transient Phenomenon

Marstrand, Peter; Jensen, Mads Christian; Ihlemann, Nikolaj

doi:10.1155/2015/380765

Cited by 4 publications

(7 citation statements)

References 4 publications

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“…16 Additionally, this study recommended that a TEE be performed just prior to undergoing surgical intervention, as the lesion disappeared on TEE during anesthesia on the day of the surgery, which resulted in the surgery being cancelled. 16 Another TEE was performed 3 weeks later, which did not show any lesion. 16 Results of various treatment approaches for cases with ⩾1 embolic attack while not on antiplatelets/anticoagulants were analyzed.…”

Section: Resultsmentioning

confidence: 99%

“…10 A study claimed that LE can be a transient lesion and disappear over time. 16 Additionally, this study recommended that a TEE be performed just prior to undergoing surgical intervention, as the lesion disappeared on TEE during anesthesia on the day of the surgery, which resulted in the surgery being cancelled. 16 Another TEE was performed 3 weeks later, which did not show any lesion.…”

Section: Resultsmentioning

confidence: 99%

“…12 While most LEs are asymptomatic and found incidentally on echocardiography or autopsy, they are considered as a rare cause of thromboembolism, commonly from the aortic valve, either through fragmentation or microthrombi formation on top of the lesions, leading to ischemic stroke, TIA, acute coronary syndrome, or peripheral thromboembolism (retinal, renal, popliteal). [1][2][3][4][5][6][7][8][9][10][12][13][14][15][16][17] A study involving 224 patients with recent stroke and 85 controls found LE present in 74 patients (33%) compared to only 6 patients (7.1%) from the control group. 18 It was concluded that LE is strongly associated with recent ischemic strokes in a multivariate analysis (odds ratio: 6.93, 90% confidence interval: 3.18-15.12; P-value < .001).…”

Section: Resultsmentioning

confidence: 99%

“…16 Another TEE was performed 3 weeks later, which did not show any lesion. 16 Results of various treatment approaches for cases with ⩾1 embolic attack while not on antiplatelets/anticoagulants were analyzed. Seven out of 10 patients who received Aspirin were followed-up, and the recurrence rate for an embolic attack during a period range of 2 to 36 months with a mean of 13.6 months was 0.…”

Section: Resultsmentioning

confidence: 99%

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Lambl’s Excrescence as an Etiology of Thromboembolism: Case Report and Literature Review

Alajjuri,

Alani

2023

Clin Med Insights Case Rep

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Lambl’s excrescence (LE), a rare thin linear fibrous thread of collagen and elastic fibrous tissue originating at closure margins of heart valve leaflets is considered a rare cause of thromboembolism, causing ischemic stroke, transient ischemic attack (TIA), acute coronary syndrome, or peripheral thromboembolism. The gold standard for diagnosing LE is transesophageal echocardiography (TEE). Due to the rarity of the disease and lack of significant research, no guidelines exist about the management of LE. Twenty-two papers about LE were reviewed, focusing on the management aspect aiming to assist in guideline publication. Articles were retrieved using PubMed database using “Lambl’s excrescences” as a keyword. All free full text papers up to 2023 were retrieved. In this report, we present the first publication of a case of a TIA secondary to LE in the United Arab Emirates. A 53-year-old male presented with transient attacks of left monocular blindness with complete recovery 2 days later. Extensive stroke work-up was negative, except for TEE, which showed an echo-dense linear mobile structure attached to the aortic surface of the aortic valve closure margin, suggesting LE. As no guidelines exist on the management of LE, the patient was started on Clopidogrel 75 mg daily and remained asymptomatic for 2 years. After reviewing the literature, we suggest the use of Aspirin for patients with ⩾1 embolic event attributed to LE while not on antiplatelets or anticoagulants, as it is the most used and recommended treatment option and is effective in preventing recurrent thromboembolic events.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Lambl’s Excrescence as an Etiology of Thromboembolism: Case Report and Literature Review

Alajjuri,

Alani

2023

Clin Med Insights Case Rep

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“…Interestingly, there have been some anecdotal reports of spontaneous regression. For this reason, intraoperative transesophageal echocardiography is clearly indicated prior to surgical intervention [34]. However, these reports should not be used to advocate non-operative management except in very high-risk patients.…”

Section: Papillary Fibroelastomasmentioning

confidence: 99%

Non-Malignant Cardiac Tumors

Eapen¹,

Malone²,

Hanna³

et al. 2020

Embolic Diseases - Evolving Diagnostic and Management Approaches

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Cardiac tumors represent an unusual clinical problem in that they are often discovered as an incidental finding during a routine echocardiogram or in the course of a work-up for a source of embolism. Malignant tumors of the heart are either defined as primary or metastatic from an extra-cardiac primary sourceregardless, the prognosis is poor. However, there are several cardiac tumors that are characterized as being non-malignant with regard to their tumor biology, but their tendencies to cause embolic or obstructive complications can be just as catastrophic despite a lack of invasiveness or potential to metastasize. The purpose of this chapter is to review the common types of non-malignant cardiac tumors with regard to their incidence, presentation, potential for complications, and management-with emphasis on surgical indications and techniques. 2 delineated as malignant and non-malignant with malignant tumors being either primary (i.e., cardiac sarcomas) or metastatic (i.e., breast carcinoma). They are distinguished from non-malignant tumors, such as myxomas and fibroelastomas, in that the latter, despite the pathologic implications of growth (i.e., valvular obstruction) and systemic embolism, lack true metastatic potential. Nevertheless, non-malignant cardiac tumors can be clinically devastating (i.e., malignant) by their tendency to cause potentially devastating, and occasionally fatal, embolic complications [5]. MethodsThe focus of this review is on non-malignant tumors. The review methods consisted of Google Scholar (https://scholar.google.com) and PubMed (https:// www.ncbi.nlm.nih.gov/pmc/) searches with emphasis on the following key words: cardiac tumors, benign cardiac masses, myxomas, fibroelastomas, and fibromas. Additional associated search terms included: surgery, diagnosis, imaging, and management. Selected references, including manuscript abstracts and full texts, were reviewed for relevance in the context of this review.

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A Large Lambl’s Excrescence Causing Embolic Stroke in a Young Patient: A Case Report and Review of Literature

Abou-El-Hassan,

Azhar,

Ikram

et al. 2024

The Neurohospitalist

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Lambl’s excrescences (LEs) are thin, filiform and hypermobile strands that develop at the valvular coaptation sites of the heart. Since first described in 1856 by Vilém Dušan Lambl, there has been an increasing number of reports of central and peripheral emboli arising from cardiac LEs. LEs have been linked to ischemic strokes irrespective of age and comorbidities. We report one of the youngest reported cases in literature of an embolic stroke in a 25-year-old woman caused by a LE. A comprehensive workup was performed that revealed a large aortic valve LE. The patient was discharged on dual anti-platelet therapy with outpatient cardiology follow-up for surveillance echocardiograms. We then surveyed the literature and reviewed case reports and observational studies of LEs linked to systemic emboli. We found that most LEs are present on left-sided high-pressure valves especially the ventricular aspect of the aortic valves and that most reported cases of cerebral embolism had aortic valve LEs. The management of cardioembolic stroke secondary to LEs remains unclear. LEs have not been identified as a definite etiology of cardioembolic strokes warranting the need for large-scale studies to help guide the management of cardiac LEs in the setting of ischemic stroke.

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Valvular Excrescences: A Possible Transient Phenomenon

Cited by 4 publications

References 4 publications

Lambl’s Excrescence as an Etiology of Thromboembolism: Case Report and Literature Review

Lambl’s Excrescence as an Etiology of Thromboembolism: Case Report and Literature Review

Non-Malignant Cardiac Tumors

A Large Lambl’s Excrescence Causing Embolic Stroke in a Young Patient: A Case Report and Review of Literature

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